Provider Demographics
NPI:1679071583
Name:RASMUSSEN, MAJA ZAVRTANIK (LPC)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:ZAVRTANIK
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MAJA
Other - Middle Name:
Other - Last Name:ZAVRTANIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 LONGMIRE RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1819
Mailing Address - Country:US
Mailing Address - Phone:936-443-9629
Mailing Address - Fax:855-443-9630
Practice Address - Street 1:620 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1819
Practice Address - Country:US
Practice Address - Phone:936-443-9629
Practice Address - Fax:855-443-9630
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0192781101YM0800X
NMCTB-2023-0068101YP2500X
TX91577101YP2500X, 101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3770653-01Medicaid